Immunization

2015-09-22 13:28:53

  1. 1. Administration Group
    1. 1.1. TC-1
      1. 1.1.1. Send administration message
      2. 1.1.2. Consume acknowledgement message
    2. 1.2. TC-2
      1. 1.2.1. Send administration message
      2. 1.2.2. Consume acknowledgement message
    3. 1.3. TC-3
      1. 1.3.1. Send administration message
      2. 1.3.2. Consume acknowledgement message
    4. 1.4. TC-4
      1. 1.4.1. Send administration message
      2. 1.4.2. Consume acknowledgement message
    5. 1.5. TC-5
      1. 1.5.1. Send administration message
      2. 1.5.2. Consume acknowledgement message
    6. 1.6. TC-6
      1. 1.6.1. Send administration message
      2. 1.6.2. Consume acknowledgement message
    7. 1.7. TC-7
      1. 1.7.1. Send administration message
      2. 1.7.2. Consume acknowledgement message
    8. 1.8. TC-8
      1. 1.8.1. Send administration message
      2. 1.8.2. Consume acknowledgement message
    9. 1.9. TC-9
      1. 1.9.1. Send administration message
      2. 1.9.2. Consume acknowledgement message
    10. 1.10. TC-10
      1. 1.10.1. Send administration message
      2. 1.10.2. Consume acknowledgement message
    11. 1.11. TC-11
      1. 1.11.1. Send administration message
      2. 1.11.2. Consume acknowledgement message
  2. 2. Evaluated History and Forecast Group
    1. 2.1. Q R TC-1
      1. 2.1.1. send query
      2. 2.1.2. Send response
    2. 2.2. Q R TC-2
      1. 2.2.1. Send query
      2. 2.2.2. return response
    3. 2.3. Q R TC-3
      1. 2.3.1. Send Query expecting no match
      2. 2.3.2. Response where no matches were found
    4. 2.4. Q R TC-4
      1. 2.4.1. Query that finds too many matches
      2. 2.4.2. Response with too many matches

1. Administration Group

No Description

1.1. TC-1

Maximally populated child administration

Test Story

Description
A child is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message containing historical and new administrations for a child including next of kin, patient consent, VIS, funding source and VFC data.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.1.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A two month old male infant, Russell Clinton Richardson, is brought to the West Clinic for a well child visit by his mother Maria Elizabeth Richardson (nee Billington) and his father John William Richardson. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child previously received Hepatitis B vaccine 1 day after birth and 1 month after birth. The staff member determines that the patient needs DTaP, Hib, IPV, Rotavirus and Pneumococcal vaccinations. Because of the patient’s status of Native American, he qualifies for all Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible – American Indian/Alaska Native. The parents are given 5 Vaccine Information Sheets (VIS) to review. After reading them, they agree that the child should receive all the vaccinations recommended. They also agree that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTaP/Hib/IPV (Pentacel), Rotavirus (RotaTeq) and Pneumococcal (Prevnar 13) are selected from the clinic’s stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID wcApp
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID issApp
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624073733.994-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 12462
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 3123
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Richardson
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Russell
PID.5.3 Second and Further Given Names or Initials Thereof Clint
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Billington
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20150415
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 1002-5
PID.10.2 Text American Indian or Alaska Native
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 543 Blount Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5557690
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 07
PD1.11.2 Text Recall only - no calls
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150415
PD1.18 Publicity Code Effective Date 20150624

NK1[*]
NK1 - 1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Richardson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Maria
NK1.2.3 Second and Further Given Names or Initials Thereof Elizabeth
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 543 Blount Drive
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5557690

NK1 - 2
Location Data Element Data Categorization
NK1.1 Set ID - NK1 2
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Richardson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name John
NK1.2.3 Second and Further Given Names or Initials Thereof William
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 543 Blount Drive
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type CP
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5558299

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 3140
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 38766
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 8681
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 65138
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7491
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 79539
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 9077
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31528
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 299
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 82668
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 49281-0560-05
RXA.5.2 Text Pentacel
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 526434
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150722
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4047-20
RXA.5.2 Text RotaTeq
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 2.0
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 297961
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150916
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00005-1971-01
RXA.5.2 Text Prevnar 13
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 353480
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150729
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150416
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150515
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38288
RXR.1.2 Text Oral
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier
RXR.2.2 Text
RXR.2.3 Name of Coding System
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID wcApp
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID issApp
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624073733.994-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 12462
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 3123
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Richardson
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Russell
PID.5.3 Second and Further Given Names or Initials Thereof Clint
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Billington
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20150415
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 1002-5
PID.10.2 Text American Indian or Alaska Native
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 543 Blount Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5557690
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 07
PD1.11.2 Text Recall only - no calls
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150415
PD1.18 Publicity Code Effective Date 20150624

NK1 - 1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Richardson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Maria
NK1.2.3 Second and Further Given Names or Initials Thereof Elizabeth
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 543 Blount Drive
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5557690

NK1 - 2
Location Data Element Data Categorization
NK1.1 Set ID - NK1 2
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Richardson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name John
NK1.2.3 Second and Further Given Names or Initials Thereof William
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 543 Blount Drive
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type CP
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5558299

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 3140
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 38766
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 8681
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 65138
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7491
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 79539
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 9077
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31528
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 299
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 82668
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 49281-0560-05
RXA.5.2 Text Pentacel
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 526434
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150722
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4047-20
RXA.5.2 Text RotaTeq
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 2.0
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 297961
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150916
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00005-1971-01
RXA.5.2 Text Prevnar 13
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 353480
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150729
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150416
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150515
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38288
RXR.1.2 Text Oral
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier
RXR.2.2 Text
RXR.2.3 Name of Coding System
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Russell Clint Richardson
Mother's Maiden Name Billington
ID Number 3123
Date/Time of Birth 04/15/2015
Administrative Sex Male
Patient Address 543 Blount Drive Bozeman MT 59715 USA
Local Number (406)555-7690
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/15/2015
Publicity Code Recall only - no calls
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party[*]
Guardian or Responsible Party - 1
Element Data
Name Maria Elizabeth Richardson
Relationship Mother
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-7690

Guardian or Responsible Party - 2
Element Data
Name John William Richardson
Relationship Father
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-8299

Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code Pentacel
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 526434
Substance Expiration Date 07/22/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Polio VIS
Date Vis Presented 06/24/2015
Document Type Hepatitis B VIS
Date Vis Presented 06/24/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 2
Element Data
Administered Code RotaTeq
Date/Time Start of Administration 06/24/2015
Administered Amount 2.0
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 297961
Substance Expiration Date 09/16/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Oral
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Rotavirus VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 3
Element Data
Administered Code Prevnar 13
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 353480
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Pneumococcal Conjugate (PCV13) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 4
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 04/16/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information - 5
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 05/15/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Element Data
Patient Name Russell Clint Richardson
Mother's Maiden Name Billington
ID Number 3123
Date/Time of Birth 04/15/2015
Administrative Sex Male
Patient Address 543 Blount Drive Bozeman MT 59715 USA
Local Number (406)555-7690
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/15/2015
Publicity Code Recall only - no calls
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party - 1
Element Data
Name Maria Elizabeth Richardson
Relationship Mother
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-7690

 Guardian or Responsible Party - 2
Element Data
Name John William Richardson
Relationship Father
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-8299
Vaccine Administration Information - 1
Element Data
Administered Code Pentacel
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 526434
Substance Expiration Date 07/22/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Polio VIS
Date Vis Presented 06/24/2015
Document Type Hepatitis B VIS
Date Vis Presented 06/24/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 2
Element Data
Administered Code RotaTeq
Date/Time Start of Administration 06/24/2015
Administered Amount 2.0
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 297961
Substance Expiration Date 09/16/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Oral
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Rotavirus VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 3
Element Data
Administered Code Prevnar 13
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 353480
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Pneumococcal Conjugate (PCV13) VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 4
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 04/16/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information - 5
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 05/15/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.1.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624073734.034-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 23628
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 12462

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624073734.034-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 23628
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 12462

Juror Document

Return an Acknowledgement
Test Case ID TC-1
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.2. TC-2

Adult administration

Test Story

Description
An adult is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for an adult containing historical and new administrations including VIS and not eligible VFC.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.2.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 32 year old female, Elise Wong, visits the West Clinic for a well woman visit. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that Elise has received her influenza vaccinations on 10/12/2014 and 11/12/2013, but is in need of a tetanus booster. Because of the patient’s age she does not qualify for Vaccine For Children (VFC) supplied vaccine. Elise is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees to receive the recommended vaccination. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Tdap (TENIVAC) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624084727.655-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 72268
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 90012
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Wong
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Elise
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19830615
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2028-9
PID.10.2 Text Asian
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 9200 Wellington Trail
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5557896
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Elise.Wong@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 19830615
PD1.18 Publicity Code Effective Date 20150624

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 4422
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 13696
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 6139
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 38760
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7600
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 35508
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 49281-0215-88
RXA.5.2 Text TENIVAC
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 315841
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151216
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141012
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131112
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624084727.655-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 72268
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 90012
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Wong
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Elise
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19830615
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2028-9
PID.10.2 Text Asian
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 9200 Wellington Trail
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5557896
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Elise.Wong@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 19830615
PD1.18 Publicity Code Effective Date 20150624

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 4422
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 13696
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 6139
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 38760
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7600
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 35508
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 49281-0215-88
RXA.5.2 Text TENIVAC
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 315841
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151216
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141012
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131112
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Elise Wong
Mother's Maiden Name
ID Number 90012
Date/Time of Birth 06/15/1983
Administrative Sex Female
Patient Address 9200 Wellington Trail Bozeman MT 59715 USA
Local Number (406)555-7896
Email Elise.Wong@isp.com
Race Asian
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/15/1983
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code TENIVAC
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 315841
Substance Expiration Date 12/16/2015
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Tetanus/Diphtheria (Td) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 2
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 10/12/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information - 3
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 11/12/2013
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Element Data
Patient Name Elise Wong
Mother's Maiden Name
ID Number 90012
Date/Time of Birth 06/15/1983
Administrative Sex Female
Patient Address 9200 Wellington Trail Bozeman MT 59715 USA
Local Number (406)555-7896
Email Elise.Wong@isp.com
Race Asian
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/15/1983
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Vaccine Administration Information - 1
Element Data
Administered Code TENIVAC
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 315841
Substance Expiration Date 12/16/2015
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Tetanus/Diphtheria (Td) VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 2
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 10/12/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information - 3
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 11/12/2013
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.2.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624084727.669-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 74602
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 72268

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624084727.669-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 74602
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 72268

Juror Document

Return an Acknowledgement
Test Case ID TC-2
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.3. TC-3

Child administration without consent for sharing

Test Story

Description
A child is seen at a clinic. A new vaccine is administered and documented but the information is not to shared by the IIS.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for a child containing a new administration but an indication that the data should not be shared.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.3.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

An 11.5 year old female, Katherine Mackenzie Benton, is brought to the West Clinic for a third and final dose of HPV vaccine. She is accompanied by her mother Kari Michelle Benton (nee Jones). A clinic staff member collects basic patient demographic information including name, date of birth and sex. The mother is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, the mother agrees that the child should receive the HPV vaccine, but she chooses not to share the data once it is incorporated into the local IIS. A clinic provider, Wilma Thomas (physician ID 654) places an order for the vaccination. While the patient is covered by insurance, the plan does not cover this vaccination and she qualifies for Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible - Underinsured. An appropriate dose of HPV (CERVARIX) is selected from the clinic’s stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the dose to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.804-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 77732
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 89778
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Benton
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Katherine
PID.5.3 Second and Further Given Names or Initials Thereof Mackenzie
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Jones
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20031221
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 89 West 21st Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554019
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20031221
PD1.18 Publicity Code Effective Date 20150624

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Benton
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Kari
NK1.2.3 Second and Further Given Names or Initials Thereof Michelle
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 89 West 21st Ave
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5554019

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5237
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31309
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0830-05
RXA.5.2 Text CERVARIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 795441
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151223
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.804-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 77732
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 89778
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Benton
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Katherine
PID.5.3 Second and Further Given Names or Initials Thereof Mackenzie
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Jones
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20031221
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 89 West 21st Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554019
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20031221
PD1.18 Publicity Code Effective Date 20150624

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Benton
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Kari
NK1.2.3 Second and Further Given Names or Initials Thereof Michelle
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 89 West 21st Ave
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5554019

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5237
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31309
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0830-05
RXA.5.2 Text CERVARIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 795441
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151223
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

1.3.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 65657
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 77732

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 65657
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 77732

Juror Document

Return an Acknowledgement
Test Case ID TC-3
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.4. TC-4

Child deleted administration

Test Story

Description
A child is seen at a clinic. A previously documented vaccination is deleted due to user error.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create  a delete message for a previously sent administration.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.4.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

After administering an HPV vaccination to the 11.5 year old female Katherine Benton the clinician, Lily Jackson (ID 7824) realizes that the vaccination was documented on the incorrect patient chart. She deletes the vaccination from the patient chart and transmits the change to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.804-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 71892
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 89778
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Benton
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Katherine
PID.5.3 Second and Further Given Names or Initials Thereof Mackenzie
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Jones
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20031221
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 89 West 21st Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554019
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20031221
PD1.18 Publicity Code Effective Date 20150624

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Benton
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Kari
NK1.2.3 Second and Further Given Names or Initials Thereof Michelle
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 89 West 21st Ave
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5554019

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5237
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31309
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0830-05
RXA.5.2 Text CERVARIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 795441
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151223
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA D

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.804-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 71892
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 89778
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Benton
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Katherine
PID.5.3 Second and Further Given Names or Initials Thereof Mackenzie
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Jones
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20031221
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 89 West 21st Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554019
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20031221
PD1.18 Publicity Code Effective Date 20150624

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Benton
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Kari
NK1.2.3 Second and Further Given Names or Initials Thereof Michelle
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 89 West 21st Ave
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5554019

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5237
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31309
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0830-05
RXA.5.2 Text CERVARIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 795441
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151223
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA D

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Delete
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Delete
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

1.4.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 65657
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 71892

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 65657
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 71892

Juror Document

Return an Acknowledgement
Test Case ID TC-4
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.5. TC-5

Child partial administration

Test Story

Description
A child is seen at a clinic. A new vaccination is administered but only a partial dose is given.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for child who received a partial administration of a vaccine.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.5.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

An 18 month old male, Daryl Andre Johnson, is brought to the West Clinic for a well child visit by his father James Terrance Johnson. Daryl’s twin brother, born 5 minutes before Daryl, was not able to make it to the clinic. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires a Hep A vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the Vaccine Information Sheet (VIS) to review. After reading it, the father agrees that the child should receive the Hep A vaccine He also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep A (VAQTA) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient, however the patient moves unexpectedly during the administration and only a portion of the dose is actually administered. The clinician enters the data into the EHR as a partial administration and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 29407
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 76511
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Johnson
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Daryl
PID.5.3 Second and Further Given Names or Initials Thereof Andre
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20131203
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2054-5
PID.10.2 Text African American
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 125 Aspen Crescent
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5551807
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator Y
PID.25 Birth Order 2
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 04
PD1.11.2 Text Reminder only - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20131203
PD1.18 Publicity Code Effective Date 20150624

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Johnson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name James
NK1.2.3 Second and Further Given Names or Initials Thereof Terrance
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 125 Aspen Crescent
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5551807

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 773
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 22119
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 68736
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150729
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status PA
RXA.21 Action Code - RXA A

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.806-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 29407
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 76511
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Johnson
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Daryl
PID.5.3 Second and Further Given Names or Initials Thereof Andre
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20131203
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2054-5
PID.10.2 Text African American
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 125 Aspen Crescent
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5551807
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator Y
PID.25 Birth Order 2
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 04
PD1.11.2 Text Reminder only - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20131203
PD1.18 Publicity Code Effective Date 20150624

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Johnson
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name James
NK1.2.3 Second and Further Given Names or Initials Thereof Terrance
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 125 Aspen Crescent
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5551807

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 773
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 22119
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 68736
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150729
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status PA
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Daryl Andre Johnson
Mother's Maiden Name
ID Number 76511
Date/Time of Birth 12/03/2013
Administrative Sex Male
Patient Address 125 Aspen Crescent Bozeman MT 59715 USA
Local Number (406)555-1807
Race African American
Ethnic Group Not Hispanic or Latino
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/03/2013
Publicity Code Reminder only - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name James Terrance Johnson
Relationship Father
Address 125 Aspen Crescent Bozeman MT 59715 USA
Phone Number (406)555-1807

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 68736
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status PA
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015
Element Data
Patient Name Daryl Andre Johnson
Mother's Maiden Name
ID Number 76511
Date/Time of Birth 12/03/2013
Administrative Sex Male
Patient Address 125 Aspen Crescent Bozeman MT 59715 USA
Local Number (406)555-1807
Race African American
Ethnic Group Not Hispanic or Latino
Birth Order 2
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/03/2013
Publicity Code Reminder only - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Element Data
Name James Terrance Johnson
Relationship Father
Address 125 Aspen Crescent Bozeman MT 59715 USA
Phone Number (406)555-1807
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 68736
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status PA
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

1.5.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.807-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 51291
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 29407

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.807-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 51291
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 29407

Juror Document

Return an Acknowledgement
Test Case ID TC-5
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.6. TC-6

Child administration with refusal

Test Story

Description
A child is seen at a clinic. A new vaccinations are administered but an additional one is refused by the parents.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for child whose parents have refused an immunization.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.6.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 1 year old male, Tyler Owen Banks, is brought to the West Clinic for a well child visit. He is accompanied by his father Karl Leonard Banks. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Joe Smith (physician ID 123) reviews the patient’s vaccination history and determines that the child requires Hib, Hep A, MMR and Varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the appropriate Vaccine Information Sheets (VIS) to review. After reading them, the father agrees that the child should receive the Hib, Hep A and MMR vaccines but refuses the Varicella vaccine. He also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of Hib (HIBERIX), Hep A (VAQTA) and MMR (M-M-R II) are selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 456) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.808-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 18019
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 8891
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Banks
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Tyler
PID.5.3 Second and Further Given Names or Initials Thereof Owen
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20140602
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 924 Sycamore Lane
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555835
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20040602
PD1.18 Publicity Code Effective Date 20150624

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Banks
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Karl
NK1.2.3 Second and Further Given Names or Initials Thereof Leonard
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 924 Sycamore Lane
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5555835

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5645
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 22515
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5027
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 12128
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7239
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 50588
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0806-01
RXA.5.2 Text HIBERIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 328734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150923
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 208940
RXA.16 Substance Expiration Date
RXA.16.1 Time 20160120
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4681-01
RXA.5.2 Text M-M-R II
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 134301
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151028
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 21
RXA.5.2 Text varicella
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300026411141022
OBX.5.2 Text Multiple Vaccines VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300012711120420
OBX.5.2 Text Measles/Mumps/Rubella VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.808-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 18019
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 8891
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Banks
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Tyler
PID.5.3 Second and Further Given Names or Initials Thereof Owen
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20140602
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 924 Sycamore Lane
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555835
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20040602
PD1.18 Publicity Code Effective Date 20150624

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Banks
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Karl
NK1.2.3 Second and Further Given Names or Initials Thereof Leonard
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 924 Sycamore Lane
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5555835

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5645
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 22515
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5027
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 12128
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7239
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 50588
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0806-01
RXA.5.2 Text HIBERIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 328734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150923
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 208940
RXA.16 Substance Expiration Date
RXA.16.1 Time 20160120
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4681-01
RXA.5.2 Text M-M-R II
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 134301
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151028
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 21
RXA.5.2 Text varicella
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300026411141022
OBX.5.2 Text Multiple Vaccines VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300012711120420
OBX.5.2 Text Measles/Mumps/Rubella VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code HIBERIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 328734
Substance Expiration Date 09/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Multiple Vaccines VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 2
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208940
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 3
Element Data
Administered Code M-M-R II
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 134301
Substance Expiration Date 10/28/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information - 4
Element Data
Administered Code varicella
Date/Time Start of Administration 06/24/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835
Vaccine Administration Information - 1
Element Data
Administered Code HIBERIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 328734
Substance Expiration Date 09/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Multiple Vaccines VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 2
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208940
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 3
Element Data
Administered Code M-M-R II
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 134301
Substance Expiration Date 10/28/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella VIS
Date Vis Presented 06/24/2015

 Vaccine Administration Information - 4
Element Data
Administered Code varicella
Date/Time Start of Administration 06/24/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.6.2. Consume acknowledgement message

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.822-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 79946
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 18019

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.822-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 79946
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 18019

Juror Document

Return an Acknowledgement
Test Case ID TC-6
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.7. TC-7

Child updated administration

Test Story

Description
A child is seen at a clinic. A previously documented vaccination is updated to correct inaccurate information..

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
This test case asses the ability of the EHR to create an update message for a previously sent administration.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.7.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

After document vaccinations for Tyler Owen Banks the clinician, Lily Jackson (ID 456) recognizes that an error was made during data entry for the Hepatitis A vaccine. The Lot Number was entered incorrectly. She updates the data in the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.808-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 18019
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 8891
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Banks
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Tyler
PID.5.3 Second and Further Given Names or Initials Thereof Owen
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20140602
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 924 Sycamore Lane
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555835
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20040602
PD1.18 Publicity Code Effective Date 20150624

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Banks
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Karl
NK1.2.3 Second and Further Given Names or Initials Thereof Leonard
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 924 Sycamore Lane
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5555835

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5027
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 12128
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 208490
RXA.16 Substance Expiration Date
RXA.16.1 Time 20160120
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA U

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.808-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 18019
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 8891
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Banks
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Tyler
PID.5.3 Second and Further Given Names or Initials Thereof Owen
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20140602
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 924 Sycamore Lane
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555835
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150624
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20040602
PD1.18 Publicity Code Effective Date 20150624

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Banks
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Karl
NK1.2.3 Second and Further Given Names or Initials Thereof Leonard
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier FTH
NK1.3.2 Text Father
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 924 Sycamore Lane
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5555835

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 5027
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 12128
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150624
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4095-01
RXA.5.2 Text VAQTA
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 208490
RXA.16 Substance Expiration Date
RXA.16.1 Time 20160120
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA U

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier PHC70
OBX.5.2 Text Private
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC Eligible
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150624
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150624
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208490
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Update
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208490
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Update
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

1.7.2. Consume acknowledgement message

ests the ability to consume a valid ACK message

Test Story

Description
The IIS returns an acknowledgement message indicating that a fatal error was found during the course of processing the message.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.822-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 79946
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 18019

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150624093847.822-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 79946
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 18019

Juror Document

Return an Acknowledgement
Test Case ID TC-7
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.8. TC-8

Historical administration resulting in fatal error

Test Story

Description
A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal error being returned by the IIS.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.8.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 66 year old female, Helen Barrett, comes to the West Clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that she received a Zoster vaccination at a local pharmacy on her 65th birthday. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625121047.839-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 35560
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 7120
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Barrett
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Helen
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19500317
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 763 Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554064
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Helen.Barrett@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 06
PD1.11.2 Text Recall only - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 19500317
PD1.18 Publicity Code Effective Date 20150625

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7646
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 53100
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150317
RXA.5 Administered Code
RXA.5.1 Identifier 121
RXA.5.2 Text zoster
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625121047.839-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 35560
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 7120
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Barrett
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Helen
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19500317
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 763 Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5554064
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Helen.Barrett@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 06
PD1.11.2 Text Recall only - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 19500317
PD1.18 Publicity Code Effective Date 20150625

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7646
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 53100
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150317
RXA.5 Administered Code
RXA.5.1 Identifier 121
RXA.5.2 Text zoster
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Test Data Specification

Patient Information
Element Data
Patient Name Helen Barrett
Mother's Maiden Name
ID Number 7120
Date/Time of Birth 03/17/1950
Administrative Sex Female
Patient Address 763 Main St Bozeman MT 59715 USA
Local Number (406)555-4064
Email Helen.Barrett@isp.com
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 03/17/1950
Publicity Code Recall only - any method
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code zoster
Date/Time Start of Administration 03/17/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Element Data
Patient Name Helen Barrett
Mother's Maiden Name
ID Number 7120
Date/Time of Birth 03/17/1950
Administrative Sex Female
Patient Address 763 Main St Bozeman MT 59715 USA
Local Number (406)555-4064
Email Helen.Barrett@isp.com
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 03/17/1950
Publicity Code Recall only - any method
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Element Data
Administered Code zoster
Date/Time Start of Administration 03/17/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.8.2. Consume acknowledgement message

Tests the ability to consume an ACK message containing a fatal error

Test Story

Description
The IIS has a mapping error in their CVX table and is unable to recognize the CVX code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine, which is a required element, and rejects the message. The acknowledgement message returned contains errors for the table mapping, missing required field (RXA-5) and missing required segment (RXA).

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
The errors returned in the ACK message must be visible in the EHR.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625121047.853-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 20428
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 35560

ERR
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXA
ERR.2.2 Segment Sequence 1
ERR.2.3 Field Position 5
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity E
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Vaccine code not recognized - message rejected

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625121047.853-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 20428
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 35560

Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXA
ERR.2.2 Segment Sequence 1
ERR.2.3 Field Position 5
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity E
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Vaccine code not recognized - message rejected

Juror Document

Return an Acknowledgement
Test Case ID TC-8
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.9. TC-9

New administration resulting in soft error

Test Story

Description
A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds a soft error (warning) which it returns in the acknowledgement message. 

Comments
No Comments

PreCondition
No PreCondition

PostCondition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with a soft warning error being returned by the IIS.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.9.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 1 month old female, Ashley Jennifer Broadbent, is brought to the West Clinic for a well child visit by her mother Ellen Broadbent (nee Layton). A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires a Hep B vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The mother is given the Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive the Hep B vaccine. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep B (ENGERIX-B) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625103328.757-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 81883
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 77100
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Broadbent
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Ashley
PID.5.3 Second and Further Given Names or Initials Thereof Jennifer
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Layton
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20150516
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2054-5
PID.10.2 Text African American
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 901 North 12th St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5552262
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 03
PD1.11.2 Text Reminder/recall - no calls
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150516
PD1.18 Publicity Code Effective Date 20150625

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Broadbent
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Ellen
NK1.2.3 Second and Further Given Names or Initials Thereof
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 901 North 12th St
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5552262

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 3881
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 13926
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0820-01
RXA.5.2 Text ENGERIX-B
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 797397
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151203
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625103328.757-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 81883
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 77100
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Broadbent
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Ashley
PID.5.3 Second and Further Given Names or Initials Thereof Jennifer
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Layton
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M
PID.7 Date/Time of Birth
PID.7.1 Time 20150516
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2054-5
PID.10.2 Text African American
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 901 North 12th St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5552262
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 03
PD1.11.2 Text Reminder/recall - no calls
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150516
PD1.18 Publicity Code Effective Date 20150625

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Broadbent
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Ellen
NK1.2.3 Second and Further Given Names or Initials Thereof
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier MTH
NK1.3.2 Text Mother
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 901 North 12th St
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5552262

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 3881
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 13926
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0820-01
RXA.5.2 Text ENGERIX-B
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 797397
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151203
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Ashley Jennifer Broadbent
Mother's Maiden Name Layton
ID Number 77100
Date/Time of Birth 05/16/2015
Administrative Sex Female
Patient Address 901 North 12th St Bozeman MT 59715 USA
Local Number (406)555-2262
Race African American
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 05/16/2015
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Ellen Broadbent
Relationship Mother
Address 901 North 12th St Bozeman MT 59715 USA
Phone Number (406)555-2262

Vaccine Administration Information
Element Data
Administered Code ENGERIX-B
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 797397
Substance Expiration Date 12/03/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis B VIS
Date Vis Presented 06/25/2015
Element Data
Patient Name Ashley Jennifer Broadbent
Mother's Maiden Name Layton
ID Number 77100
Date/Time of Birth 05/16/2015
Administrative Sex Female
Patient Address 901 North 12th St Bozeman MT 59715 USA
Local Number (406)555-2262
Race African American
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 05/16/2015
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Element Data
Name Ellen Broadbent
Relationship Mother
Address 901 North 12th St Bozeman MT 59715 USA
Phone Number (406)555-2262
Element Data
Administered Code ENGERIX-B
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 797397
Substance Expiration Date 12/03/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis B VIS
Date Vis Presented 06/25/2015

1.9.2. Consume acknowledgement message

Tests the ability to consume an ACK message containing a warning

Test Story

Description
A mapping error in the IIS software results in the IIS being unable to recognize the administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria

The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625103328.758-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 23842
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 81883

ERR
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 2
ERR.2.3 Field Position 1
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625103328.758-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 23842
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 81883

Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 2
ERR.2.3 Field Position 1
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

Juror Document

Return an Acknowledgement
Test Case ID TC-9
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.10. TC-10

New administration resulting in multiple soft errors

Test Story

Description
A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds multiple soft errors (warnings) which it returns in the acknowledgement message. 

Comments
No Comments

PreCondition
No PreCondition

PostCondition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with multiple soft errors being returned by the IIS.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.10.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 4 year old female, Lacy Wells, is brought to the West Clinic for a well child visit by her guardian Janelle Trudeau. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires DTaP, polio, MMR and varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The guardian is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive all the vaccines. She also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTap-IPV (KINRIX) and MMRV (ProQuad) are selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625115038.030-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 10746
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 22533
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Wells
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Lacy
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20110430
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 12 North Oak St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5552914
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20110430
PD1.18 Publicity Code Effective Date 20150625

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Trudeau
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Janelle
NK1.2.3 Second and Further Given Names or Initials Thereof
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier GRD
NK1.3.2 Text Guardian
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 12 North Oak St
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5552914

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 657
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 68544
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7553
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 8671
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4171-01
RXA.5.2 Text ProQuad
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 407453
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151015
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0812-01
RXA.5.2 Text KINRIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 88402
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150730
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625115038.030-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 10746
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 22533
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Wells
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Lacy
PID.5.3 Second and Further Given Names or Initials Thereof
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 20110430
PID.8 Administrative Sex F
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 12 North Oak St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5552914
PID.22 Ethnic Group
PID.22.1 Identifier 2186-5
PID.22.2 Text Not Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator Y
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20110430
PD1.18 Publicity Code Effective Date 20150625

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Trudeau
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Janelle
NK1.2.3 Second and Further Given Names or Initials Thereof
NK1.2.7 Name Type Code L
NK1.3 Relationship
NK1.3.1 Identifier GRD
NK1.3.2 Text Guardian
NK1.3.3 Name of Coding System HL70063
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 12 North Oak St
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Bozeman
NK1.4.4 State or Province MT
NK1.4.5 Zip or Postal Code 59715
NK1.4.6 Country USA
NK1.4.7 Address Type P
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN
NK1.5.3 Telecommunication Equipment Type PH
NK1.5.4 Email Address
NK1.5.6 Area/City Code 406
NK1.5.7 Local Number 5552914

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 657
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 68544
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 7553
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 8671
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number 654
ORC.12.2 Family Name
ORC.12.2.1 Surname Thomas
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Wilma
ORC.12.4 Second and Further Given Names or Initials Thereof Elizabeth
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID wcEHR
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code MD
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 00006-4171-01
RXA.5.2 Text ProQuad
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 407453
RXA.16 Substance Expiration Date
RXA.16.1 Time 20151015
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck and Co., Inc.
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150625
RXA.5 Administered Code
RXA.5.1 Identifier 58160-0812-01
RXA.5.2 Text KINRIX
RXA.5.3 Name of Coding System NDC
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text mL
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New Record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number 7824
RXA.10.2 Family Name
RXA.10.2.1 Surname Jackson
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lily
RXA.10.4 Second and Further Given Names or Initials Thereof Suzanne
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID wcEHR
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code L
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code PRN
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID wcEHR
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 88402
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150730
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text Intramuscular
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30963-3
OBX.3.2 Text Vaccine Funding Source
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text Vaccine Funding Program Eligibility
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier VXC40
OBX.17.2 Text per immunization
OBX.17.3 Name of Coding System CDCPHINVS
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document Type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text Date Vis Presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value 20150625
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150625
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lacy Wells
Mother's Maiden Name
ID Number 22533
Date/Time of Birth 04/30/2011
Administrative Sex Female
Patient Address 12 North Oak St Bozeman MT 59715 USA
Local Number (406)555-2914
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/30/2011
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Janelle Trudeau
Relationship Guardian
Address 12 North Oak St Bozeman MT 59715 USA
Phone Number (406)555-2914

Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code ProQuad
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 407453
Substance Expiration Date 10/15/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella/Varicella VIS
Date Vis Presented 06/25/2015

Vaccine Administration Information - 2
Element Data
Administered Code KINRIX
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 88402
Substance Expiration Date 07/30/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Polio VIS
Date Vis Presented 06/25/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/25/2015
Element Data
Patient Name Lacy Wells
Mother's Maiden Name
ID Number 22533
Date/Time of Birth 04/30/2011
Administrative Sex Female
Patient Address 12 North Oak St Bozeman MT 59715 USA
Local Number (406)555-2914
Race White
Ethnic Group Not Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/30/2011
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Element Data
Name Janelle Trudeau
Relationship Guardian
Address 12 North Oak St Bozeman MT 59715 USA
Phone Number (406)555-2914
Vaccine Administration Information - 1
Element Data
Administered Code ProQuad
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 407453
Substance Expiration Date 10/15/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella/Varicella VIS
Date Vis Presented 06/25/2015

 Vaccine Administration Information - 2
Element Data
Administered Code KINRIX
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 88402
Substance Expiration Date 07/30/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Observations
Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Polio VIS
Date Vis Presented 06/25/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/25/2015

1.10.2. Consume acknowledgement message

Tests the ability to consume an ACK message containing multiple warnings

Test Story

Description
A mapping error in the IIS software results in the IIS being unable to recognize either administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains warnings for the invalid values.

Comments
No Comments

PreCondition
A VXU message is generated by the EHR.

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria

The errors returned in the acknowledgement message are visible in the system responsible for the content of the administration message.

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625115038.044-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 29540
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 10746

ERR[*]
ERR - 1
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 1
ERR.2.3 Field Position 2
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

ERR - 2
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 2
ERR.2.3 Field Position 2
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625115038.044-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 29540
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AE
MSA.2 Message Control ID 10746

ERR - 1
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 1
ERR.2.3 Field Position 2
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

ERR - 2
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID RXR
ERR.2.2 Segment Sequence 2
ERR.2.3 Field Position 2
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number 1
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 999
ERR.3.2 Text Application error
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity W
ERR.5 Application Error Code
ERR.5.1 Identifier 5
ERR.5.2 Text Table value not found
ERR.5.3 Name of Coding System HL70533
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Administration Site not recognized - site data will not be saved

Juror Document

Return an Acknowledgement
Test Case ID TC-10
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.11. TC-11

Historical administration resulting in system error

Test Story

Description
A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the?acknowledgement?message.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal system error being returned by the IIS.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.11.1. Send administration message

Tests the ability to create a valid VXU^V04 message

Test Story

Description

A 68 year old male, Manuel Diego Vasquez, comes to the West Clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that he received a pneumococcal vaccination at a local pharmacy on October 21, 2014. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625072816.601-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 41821
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 21142
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Vasquez
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Manuel
PID.5.3 Second and Further Given Names or Initials Thereof Diego
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19470215
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 227 Park Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555815
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Manuel.Vasquez@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2
PID.22.2 Text Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150625
PD1.18 Publicity Code Effective Date 20150625

ORC
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 4486
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31165
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141021
RXA.5 Administered Code
RXA.5.1 Identifier 152
RXA.5.2 Text Pneumococcal Conjugate, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID wcEHR
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID IIS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625072816.601-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID 41821
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name wcEHR
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name IIS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 21142
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID wcEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Vasquez
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Manuel
PID.5.3 Second and Further Given Names or Initials Thereof Diego
PID.5.7 Name Type Code L
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code
PID.7 Date/Time of Birth
PID.7.1 Time 19470215
PID.8 Administrative Sex M
PID.10 Race
PID.10.1 Identifier 2106-3
PID.10.2 Text White
PID.10.3 Name of Coding System CDCREC
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 227 Park Ave
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Bozeman
PID.11.4 State or Province MT
PID.11.5 Zip or Postal Code 59715
PID.11.6 Country USA
PID.11.7 Address Type P
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN
PID.13.3 Telecommunication Equipment Type PH
PID.13.4 Email Address
PID.13.6 Area/City Code 406
PID.13.7 Local Number 5555815
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code NET
PID.13.3 Telecommunication Equipment Type
PID.13.4 Email Address Manuel.Vasquez@isp.com
PID.13.6 Area/City Code
PID.13.7 Local Number
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2
PID.22.2 Text Hispanic or Latino
PID.22.3 Name of Coding System CDCREC
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator N
PID.25 Birth Order 1
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator N

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 01
PD1.11.2 Text No reminder/recall
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator N
PD1.13 Protection Indicator Effective Date 20150625
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20150625
PD1.18 Publicity Code Effective Date 20150625

Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 4486
ORC.2.2 Namespace ID wcEHR
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 31165
ORC.3.2 Namespace ID wcEHR
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number 7824
ORC.10.2 Family Name
ORC.10.2.1 Surname Jackson
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lily
ORC.10.4 Second and Further Given Names or Initials Thereof Suzanne
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID wcEHR
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code L
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code PRN
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier wcEHR
ORC.17.2 Text West Clinic
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141021
RXA.5 Administered Code
RXA.5.1 Identifier 152
RXA.5.2 Text Pneumococcal Conjugate, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Administration
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

Test Data Specification

Patient Information
Element Data
Patient Name Manuel Diego Vasquez
Mother's Maiden Name
ID Number 21142
Date/Time of Birth 02/15/1947
Administrative Sex Male
Patient Address 227 Park Ave Bozeman MT 59715 USA
Local Number (406)555-5815
Email Manuel.Vasquez@isp.com
Race White
Ethnic Group Hispanic or Latino
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/25/2015
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 10/21/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Element Data
Patient Name Manuel Diego Vasquez
Mother's Maiden Name
ID Number 21142
Date/Time of Birth 02/15/1947
Administrative Sex Male
Patient Address 227 Park Ave Bozeman MT 59715 USA
Local Number (406)555-5815
Email Manuel.Vasquez@isp.com
Race White
Ethnic Group Hispanic or Latino
Birth Order 1
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/25/2015
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Element Data
Administered Code Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 10/21/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.11.2. Consume acknowledgement message

Tests the ability to consume an ACK message containing a system error

Test Story

Description

Due to an error in the IIS software, the IIS is unable to recognize the HL7 version ID sent in MSH-12 even though it is valid. The acknowledgement message returned contains an error for an unsupported version ID.

Comments

No Comments

PreCondition

A VXU message is generated by the EHR.

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message.

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625072816.602-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 48026
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AR
MSA.2 Message Control ID 41821

ERR
Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID MSH
ERR.2.2 Segment Sequence 12
ERR.2.3 Field Position 1
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 203
ERR.3.2 Text Unsupported Version ID
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity E
ERR.5 Application Error Code
ERR.5.1 Identifier
ERR.5.2 Text
ERR.5.3 Name of Coding System
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Version ID not recognized - message rejected

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID IIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID wcEHR
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150625072816.602-0500
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID 48026
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name IIS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name wcEHR
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AR
MSA.2 Message Control ID 41821

Location Data Element Data Categorization
ERR.2 Error Location
ERR.2.1 Segment ID MSH
ERR.2.2 Segment Sequence 12
ERR.2.3 Field Position 1
ERR.2.4 Field Repetition 1
ERR.2.5 Component Number
ERR.2.6 Sub-Component Number
ERR.3 HL7 Error Code
ERR.3.1 Identifier 203
ERR.3.2 Text Unsupported Version ID
ERR.3.3 Name of Coding System HL70357
ERR.3.5 Alternate Text
ERR.3.6 Name of Alternate Coding System
ERR.4 Severity E
ERR.5 Application Error Code
ERR.5.1 Identifier
ERR.5.2 Text
ERR.5.3 Name of Coding System
ERR.5.5 Alternate Text
ERR.5.6 Name of Alternate Coding System
ERR.8 User Message Version ID not recognized - message rejected

Juror Document

Return an Acknowledgement
Test Case ID TC-11
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

2. Evaluated History and Forecast Group

This set of tests evaluates the EHR's ability to create well-formed queries and gracefully accept the response messages. It evaluates that the clinician is shown the results of the query.

2.1. Q R TC-1

QBP for young adult with immunization history

Test Story

Description

A young adult is seen by a clinician. The clinician uses the EHR to request and evaluated history and forecast.  The IIS returns an evaluated history and forecast for that person.

Comments

No Comments

PreCondition

The person has a record in the IIS.

PostCondition

No PostCondition

Test Objectives

Evaluates EHR ability to create a well formed query for a young adult. Evaluates EHR ability to accept a response with evaluated history and forecast for that person.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

2.1.1. send query

Query requests an evaluated history and forecast for a young adult

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 12993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sally
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

RCP
Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 5
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 12993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sally
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 5
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Sally S Stanley
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712
Element Data
Patient Name Sally S Stanley
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712

2.1.2. Send response

No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 4483533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name StatePH
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name DCS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID DCS
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code XX
MSH.23.10 Organization Identifier 6439432

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID 793543 System Generated

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 37374859 System Generated
QAK.2 Query Response Status OK Test Case Fixed
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 12993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sally
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 12993456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 34500907
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MyIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Stanley
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Sally
PID.5.3 Second and Further Given Names or Initials Thereof S
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 19800214
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 10 East Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Titletown
PID.11.4 State or Province WI
PID.11.5 Zip or Postal Code
PID.11.6 Country
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID MyIIS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 207023
ORC.3.2 Namespace ID MyIIS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 227023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 317023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197024
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197025
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197026
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197028
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197029
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197123
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197223
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197323
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197423
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197523
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197623
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 887834
ORC.2.2 Namespace ID MyIIS
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090515
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091215
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800615
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800815
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19811115
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19860415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800615
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800910
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19860415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100415
RXA.5 Administered Code
RXA.5.1 Identifier 100
RXA.5.2 Text PCV7
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100415
RXA.5 Administered Code
RXA.5.1 Identifier 139
RXA.5.2 Text Td NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091015
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101015
RXA.5 Administered Code
RXA.5.1 Identifier 141
RXA.5.2 Text influenza seasonal
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110901
RXA.5 Administered Code
RXA.5.1 Identifier 140
RXA.5.2 Text seasonal flu
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150531
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pnuemococcal conjugate
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.5.1 Identifier 139
OBX.5.2 Text Td NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value
OBX.5.1 Identifier 03
OBX.5.2 Text MMR
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 4483533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name StatePH
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name DCS
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID DCS
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code XX
MSH.23.10 Organization Identifier 6439432

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID 793543 System Generated

Location Data Element Data Categorization
QAK.1 Query Tag 37374859 System Generated
QAK.2 Query Response Status OK Test Case Fixed
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 12993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sally
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 12993456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 34500907
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MyIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Stanley
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Sally
PID.5.3 Second and Further Given Names or Initials Thereof S
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 19800214
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 10 East Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Titletown
PID.11.4 State or Province WI
PID.11.5 Zip or Postal Code
PID.11.6 Country
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID MyIIS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 207023
ORC.3.2 Namespace ID MyIIS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 227023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 317023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197024
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197025
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197026
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197028
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197029
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197123
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197223
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197323
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197423
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197523
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197623
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier 887834
ORC.2.2 Namespace ID MyIIS
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090515
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091215
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text Hep B NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800615
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800815
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19811115
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19860415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800615
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19800910
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19860415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100415
RXA.5 Administered Code
RXA.5.1 Identifier 100
RXA.5.2 Text PCV7
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100415
RXA.5 Administered Code
RXA.5.1 Identifier 139
RXA.5.2 Text Td NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091015
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101015
RXA.5 Administered Code
RXA.5.1 Identifier 141
RXA.5.2 Text influenza seasonal
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110901
RXA.5 Administered Code
RXA.5.1 Identifier 140
RXA.5.2 Text seasonal flu
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150531
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 45
OBX.5.2 Text Hep B NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text DTAP NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.5.1 Identifier 89
OBX.5.2 Text polio NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pnuemococcal conjugate
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.5.1 Identifier 139
OBX.5.2 Text Td NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 16
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 17
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 18
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value
OBX.5.1 Identifier 03
OBX.5.2 Text MMR
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 19
OBX.5 Observation Value 20150531
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150531

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Q R TC-1
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
12993456 Sally S Stanley 02/14/1980 Female
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History and Immunization Forecast
Immunization Schedule Used Tester Comment
ACIP


Evaluated Immunization History
Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment
Hep B NOS Hep B NOS 04/15/2009 YES Complete
Hep B NOS Hep B NOS 05/15/2009 YES Complete
Hep B NOS Hep B NOS 12/15/2009 YES Complete
DTAP NOS DTP 04/15/1980 YES Complete
DTAP NOS DTP 06/15/1980 YES Complete
DTAP NOS DTP 08/15/1980 YES Complete
DTAP NOS DTP 11/15/1981 YES Complete
DTAP NOS DTP 04/15/1986 YES Complete
polio NOS polio NOS 04/15/1980 YES Complete
polio NOS polio NOS 06/15/1980 YES Complete
polio NOS polio NOS 09/10/1980 YES Complete
polio NOS polio NOS 04/15/1986 YES Complete
pnuemococcal conjugate PCV7 04/15/2010 YES Complete
Td NOS Td NOS 04/15/2010 YES Complete
influenza NOS influenza NOS 10/15/2009 YES Complete
influenza NOS influenza seasonal 10/15/2010 YES Complete
influenza NOS seasonal flu 09/01/2011 YES Complete
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment
influenza NOS 05/31/2015 05/31/2015
MMR 05/31/2015 05/31/2015

2.2. Q R TC-2

Adult with immunizations, including smallpox

Test Story

Description

This test requests an evaluated history and forecast for an adult with a small pox vaccination.

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

The objective is to evaluate the ability of the EHR to gracefully handle an immunization with no validation and not forecast.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

2.2.1. Send query

No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20141031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Clement
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Smith
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19500214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Titletown
QPD.8.4 State or Province WI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 690
QPD.9.7 Local Number 1231234
QPD.10 Multiple birth indicator
QPD.11 Birth order

RCP
Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity
RCP.2.2 Units
RCP.2.2.1 Identifier
RCP.2.2.2 Text
RCP.2.2.3 Name of Coding System
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20141031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Clement
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Smith
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19500214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Titletown
QPD.8.4 State or Province WI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 690
QPD.9.7 Local Number 1231234
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity
RCP.2.2 Units
RCP.2.2.1 Identifier
RCP.2.2.2 Text
RCP.2.2.3 Name of Coding System
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Clement S Stanley
Date/Time of Birth 02/14/1950
Sex Male
Patient Address 10 East Main St Titletown WI
Patient Phone (690)123-1234
Element Data
Patient Name Clement S Stanley
Date/Time of Birth 02/14/1950
Sex Male
Patient Address 10 East Main St Titletown WI
Patient Phone (690)123-1234

2.2.2. return response

return response to query for an adult with historical smallpox vaccination

Test Story

Description
Query is returned for Clement S Stanley. Clement has a number of historical dose records, including one for small pox. This vaccine is not validated and so has no dose validity. All other doses are valid. Mr. Stanley is due for a pneumococcal vaccine and an influenza vaccine.

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
Deomonstrate capability to receive a response file with a number of doses adminsitered, both current and historical. Also demonstrate capability to display a vaccination that is not validated.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20141031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Clement
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Smith
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19500214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Titletown
QPD.8.4 State or Province WI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 690
QPD.9.7 Local Number 1231234
QPD.10 Multiple birth indicator
QPD.11 Birth order

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 34500907
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MyIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Stanley
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Clement
PID.5.3 Second and Further Given Names or Initials Thereof S
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 19500214
PID.8 Administrative Sex M
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 10 East Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Titletown
PID.11.4 State or Province WI
PID.11.5 Zip or Postal Code
PID.11.6 Country
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1970213
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1972023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1973023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19703423
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19722023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19701223
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 45197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19577023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19799023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197789023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 193337027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090515
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091215
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600615
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600910
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19610415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20130415
RXA.5 Administered Code
RXA.5.1 Identifier 33
RXA.5.2 Text pneumococcal ppv23
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 139
RXA.5.2 Text Td NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091015
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101015
RXA.5 Administered Code
RXA.5.1 Identifier 141
RXA.5.2 Text influenza seasonal
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110901
RXA.5 Administered Code
RXA.5.1 Identifier 140
RXA.5.2 Text seasonal flu
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sticker
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Nurse
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value 20150214
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text iwehwieofnd
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20151111
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

RXR
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier
RXR.2.2 Text
RXR.2.3 Name of Coding System
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20141031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 443533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Stanley
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Clement
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Smith
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19500214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Titletown
QPD.8.4 State or Province WI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 690
QPD.9.7 Local Number 1231234
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 34500907
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MyIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Stanley
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Clement
PID.5.3 Second and Further Given Names or Initials Thereof S
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 19500214
PID.8 Administrative Sex M
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 10 East Main St
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Titletown
PID.11.4 State or Province WI
PID.11.5 Zip or Postal Code
PID.11.6 Country
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1970213
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1972023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 1973023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19703423
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19722023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19701223
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 45197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19577023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 19799023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197789023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 193337027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier DCS
ORC.17.2 Text Dabig Clinical System
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090515
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091215
RXA.5 Administered Code
RXA.5.1 Identifier 31
RXA.5.2 Text Hep B Peds NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600415
RXA.5 Administered Code
RXA.5.1 Identifier 01
RXA.5.2 Text DTP
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600615
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19600910
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 19610415
RXA.5 Administered Code
RXA.5.1 Identifier 89
RXA.5.2 Text polio NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20130415
RXA.5 Administered Code
RXA.5.1 Identifier 33
RXA.5.2 Text pneumococcal ppv23
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20090415
RXA.5 Administered Code
RXA.5.1 Identifier 139
RXA.5.2 Text Td NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091015
RXA.5 Administered Code
RXA.5.1 Identifier 88
RXA.5.2 Text influenza NOS
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101015
RXA.5 Administered Code
RXA.5.1 Identifier 141
RXA.5.2 Text influenza seasonal
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110901
RXA.5 Administered Code
RXA.5.1 Identifier 140
RXA.5.2 Text seasonal flu
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sticker
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Nurse
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20141031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 4
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 5
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 6
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 7
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 8
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 9
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 10
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 11
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 12
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 13
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141031

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value 20150214
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 14
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text iwehwieofnd
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20151111
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest Date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 15
OBX.5 Observation Value 20150914
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text
RXR.1.6 Name of Alternate Coding System
RXR.2 Administration Site
RXR.2.1 Identifier
RXR.2.2 Text
RXR.2.3 Name of Coding System
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Q R TC-2
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
123456 Clement S Stanley 02/14/1950 Male
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History and Immunization Forecast
Immunization Schedule Used Tester Comment
ACIP


Evaluated Immunization History
Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment
Hep B NOS Hep B Peds NOS 04/15/2009 YES Complete
Hep B NOS Hep B Peds NOS 05/15/2009 YES Complete
Hep B NOS Hep B Peds NOS 12/15/2009 YES Complete
DTAP NOS DTP 04/15/1960 YES Complete
polio NOS polio NOS 04/15/1960 YES Complete
polio NOS polio NOS 06/15/1960 YES Complete
polio NOS polio NOS 09/10/1960 YES Complete
polio NOS polio NOS 04/15/1961 YES Complete
pneumococcal ppv23 pneumococcal ppv23 04/15/2013 YES Complete
Td NOS Td NOS 04/15/2009 YES Complete
influenza NOS influenza NOS 10/15/2009 YES Complete
influenza NOS influenza seasonal 10/15/2010 YES Complete
influenza NOS seasonal flu 09/01/2011 YES Complete
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment
pcv NOS 02/14/2015 09/14/2015 11/11/2015
influenza NOS 09/14/2015 09/14/2015 11/11/2015

2.3. Q R TC-3

Tests ability to send a query and receive a response where no patients are found.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

2.3.1. Send Query expecting no match

This query should return a response where no matches are found.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator | Test Case Fixed
MSH.2 Encoding Characters ^~\& Test Case Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 993533469 Content Indifferent
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER Test Case Fixed
MSH.16 Application Acknowledgment Type AL Test Case Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859 Content Indifferent
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Standard
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

RCP
Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 1
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator | Test Case Fixed
MSH.2 Encoding Characters ^~\& Test Case Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 993533469 Content Indifferent
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER Test Case Fixed
MSH.16 Application Acknowledgment Type AL Test Case Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859 Content Indifferent
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Standard
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 1
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Sam S Standard
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712
Element Data
Patient Name Sam S Standard
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712

2.3.2. Response where no matches were found

Response with no matches found

Test Story

Description

No Description

Comments

No Comments

PreCondition

query finds no matches

PostCondition

Clinician is alerted to fact of no matches.

Test Objectives

No Test Objectives

Evaluation Criteria

Clinician is notified of no match.

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20151031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 3533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z33
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 993533469

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status NF
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Standard
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20151031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 3533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z33
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 993533469

Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status NF
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Standard
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Q R TC-3
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
177993456 Sam S Standard 02/14/1980 Male
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.


Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.

2.4. Q R TC-4

Query finds too many matches

Test Story

Description

This test evaluates the ability of the EHR to gracefully accept a response where too many matches are found, based on the parameters sent in the query. Note that this query only expects an evaluated history and forecast when an exact match is found.

Comments

The intiating clinician should be alerted to the failure to get an exact match.

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

The intiating clinician should be alerted to the failure to get an exact match.

Evaluation Criteria

The EHR receives the response and alerts the clinician that too many matches were found.

Notes to Testers

No Note

2.4.1. Query that finds too many matches

Query will find too many matches

Test Story

Description

This test sends a query that will find too many matches. 

Comments

The sending system will need to accept a response indicating that too many matches were found. 

PreCondition

More than one person in the IIS matching the parameters in the query exists.

PostCondition

Response indicates that there are more than one match (too many) and the clinician is informed.

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator | Test Case Fixed
MSH.2 Encoding Characters ^~\& Test Case Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 113533469 Content Indifferent
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER Test Case Fixed
MSH.16 Application Acknowledgment Type AL Test Case Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 3137374859 Content Indifferent
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Johnson
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

RCP
Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 1
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator | Test Case Fixed
MSH.2 Encoding Characters ^~\& Test Case Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID MyEHR
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID DCS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MyIIS
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID StatePH
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150531145156-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 113533469 Content Indifferent
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER Test Case Fixed
MSH.16 Application Acknowledgment Type AL Test Case Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 3137374859 Content Indifferent
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Johnson
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity 1
RCP.2.2 Units
RCP.2.2.1 Identifier RD
RCP.2.2.2 Text Records
RCP.2.2.3 Name of Coding System HL70126
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Sam S Johnson
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712
Element Data
Patient Name Sam S Johnson
Date/Time of Birth 02/14/1980
Sex Male
Patient Address 10 East Main St Pretty Valley MI
Patient Phone (734)555-6712

2.4.2. Response with too many matches

No Description

Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

Clinician is alerted to multiple match condition.

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20151031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 3533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z33
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 113533469

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 3137374859
QAK.2 Query Response Status TM
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 3137374859
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Johnson
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MyIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID StatePH
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID DCS
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20151031145233-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 3533469
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z33
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name DCS
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID DCS
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code XX
MSH.22.10 Organization Identifier 6439432
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name StatePH
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 113533469

Location Data Element Data Categorization
QAK.1 Query Tag 3137374859
QAK.2 Query Response Status TM
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text request evaluated Immunization history
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 3137374859
QPD.3 PatientList
QPD.3.1 ID Number 177993456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Johnson
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Sam
QPD.4.3 Second and Further Given Names or Initials Thereof S
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code
QPD.6 PatientDateOfBirth
QPD.6.1 Time 19800214
QPD.7 Patient Sex M
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 10 East Main St
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Pretty Valley
QPD.8.4 State or Province MI
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 734
QPD.9.7 Local Number 5556712
QPD.10 Multiple birth indicator
QPD.11 Birth order

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Q R TC-4
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
177993456 Sam S Johnson 02/14/1980 Male
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.


Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query.